SCAN

CHECK

ALERT/READY

EMERGENCY

C

Circulation

Note the rate, rhythm and volume of the pulse and note the end tidal carbon dioxide concentration(ETCO2).
 

Palpate a pulse. Correlate rate, rhythm and volume with the oximeter and ECG. Check capillary refill and ETCO2 trace.

Circulation: If there is an impending arrest allocate the circulation" task and ask for the arrest trolley to be fetched

If the pulse or ETCO2 fails, feel for a major pulse and start external cardiac massage

Colour

Note the colour of the patient's mucous membranes and blood and note the saturation reading of the oximeter (SaO2).

If suspicious try the pulse oximeter on yourself. Take arterial blood for a lab check on saturation or blood gases.

If the oximeter is suspect, resite or replace it and/or do an arterial blood gas. Consider inserting an arterial line..

If there is any question of cardiac, circulatory or respiratory compromise, give 100% O2 regardless of the saturation

O

Oxygen Supply

Note the rotameter settings and that the bobbins are spinning and calculate the inspired oxygen fraction (FIO2). 

Briefly increase the oxygen flow rate and calculate the new expected FIO2 in the breathing circuit.

If adequate saturation cannot be confirmed, administer 100% oxygen. Plan how to provide analgesia and anaesthesia

Supply 100% oxygen at a very high flow rate if necessary

Oxygen Analyser

 Note that the
readout matches that expected in the inspiratory limb of the breathing
circuit. Calibrate if necessary

Check that the changes in the FIO2 are in line with the calculated changes in FIO2 in the breathing circuit.

Confirm that the gas in the inspired limb of the breathing circuit is 100% oxygen.

Confirm the inspired gas in the breathing circuit is 100% oxygen.

 V

 Ventilation

 Note the patient's chest movements. Correlate these with the capnograph, breathing circuit pressures and tidal volumes.

Ventilate by hand and repeat SCAN. Check circuit, scavenging, valves and visible moving ventilator parts.

Allocate the "airway and breathing" task. Ventilate with a self-inflating bag. See breathing below.

Ventilate by hand - use a self-inflating bag. Obtain appropriate chest movement, airway pressures and ETCO2 .

Vaporisers

 Note the vaporiser settings on all vaporisers and the volatile agent liquid level on the vaporiser in use

Check the vaporiser(s) are correctly seated and set, "locked in" and connected and that there are no gas or liquid leaks.

Turn the vaporiser off if there is cardio-respiratory compromise. Planto provide analgesia  and  anesthesia

Turn off all vaporisers unless the problem is clearly unrelated or is hypertension or awareness.

 E

Endotracheal Tube

or laryngeal mask airway: Note its position (distance marker at the lips), its orientation and its security

or laryngeal mask airway: Check position, orientation and patency. If ET tube is in use exclude endobronchial intubation.

or laryngeal mask airway:  Allocate the "equipment" task. If suspicious, prepare to remove and change the tube or LMA.

or laryngeal mask airway: Remove and replace if there is any doubt whatsoever about its position or patency.

Eliminate Circuit

 Note that, in a crisis, you may need to remove machine, circuit, filter, ETT and its connections, eg. the "catheter mount".

 Check that an independent means of ventilating the patient (eg. self-inflating bag) and an alternate supply of oxygen are available

Prepare & check the correct function of an alternate breathing system and separate oxygen source.

The machine, circuit, filter and connections unless the problem is clearly unrelated.

 R

Review Monitors

 Note monitors in use and review all readings, waveforms and alarm settings. Update the anaesthetic record.

 Check all monitors in use and compare current monitor values with those on the anaesthetic record.

Recheck, correlate and record all readouts and trends. Call for additional monitors as necessary

Frequently scan. Allocate someone to review trends and keep notes and ensure sensor integrity.

Review Equipment

 Note all equipment in use, especially items in contact with the patient. Review its safety and function.

 Check that all equipment in contact with or relevant to the patient is safe and functioning correctly

Remove or replace suspect equipment. Bring in additional emergency equipment as appropriate

Check, and remove all non-essential equipment in contact with patient (retractors, diathermy, etc.).

 A

Airway

 Note the position of the head and neck, and the position, patency and security of any artificial airways or masks.

 Observe, palpate and auscultate the neck. If suspicious of airway obstruction, plan direct pharyngoscopy

Adjust head and neck, attempt gentle chin lift. Prepare for pharyngoscopy; if suspicious, go to airway obstruction.

Suspect laryngospasm, airway obstruction, or aspiration  . Consider intubation. .

 B

Breathing

 Note chest and abdominal movements and correlate these with the respiratory rate and pattern of spontaneous ventilation.

 Palpate and auscultate the chest whilst repeating SCAN. Review the ETCO2 if a capnograph is in use.

Expose the chest and abdomen. Repeat SCAN and CHECK whilst comparing L & R sides. Consider causes

Suspect  bronchospasm, pulmonary oedema, ARDS, ventilation, desaturation . Consider ventilation.

 C

Circulation

 Note trends in all cardiovascular parameters and correlate these with estimated blood or other fluid losses.

Cross check any abnormal BP readings where possible. Check the zero and scales of transducers

Check IV access. Secure additional access (venous & arterial) as necessary. Prepare to transfuse

Suspect  tachycardia, bradycardia, hypotension, hypertension, myocardial ischaemia, or cardiac arrest .manage as indicated

D

Drugs

Note drugs that have been given and correlate doses with effects. Note correct function of all IV lines and infusions.

Check all ampoules, syringes, labels, infusion apparatus, connections &cannulae from fluid source to vein.

Allocate the "drugs" task. Check all drugs & infusions & the entire IV apparatus. Draw up, check & label drugs that may be needed.

Has there been an error? Ensure all drugs are labelled and keep a record of doses and times.

A

"Be Aware of Air and Allergy". Be Aware yourself, think of possible Awareness in the patient, and of Air (or other) embolism, Air in the pleura (pneumothorax), Allergy or Anaphylaxis.

Specifically consider the possibility ofAwareness. 
Air (or other) embolism. 
Air in pleura (pneumothorax): 
Allergy or Anaphylaxis.

Decide whether Awareness, Air (or other) embolism, Air in pleura (pneumothorax), Allergy and Anaphylaxis are possible causes of the problem, and act accordingly .

Suspect awareness, air (and other) embolism, air in pleura (pneumothorax) and anaphylaxis and manage  as indicated.

SWIFT CHECK

Note what the surgeon and other personnel are doing, check the patient's position on the table and that the physiological responses match the circumstances.

Correlate the monitored parameters with the clinical situation and risk factors. Specifically question the surgeon about what is being done, and check the pre-operative assessment, medical record and ward drug chart.

Make another assessment of the general situation, of the patient, of the activities of the surgeon and other personnel, and of the possible effects of the operation and/or any drugs or infusions

Go through when there is time.